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OBJECTIVE: To evaluate the feasibility of a study on the content and effect of comprehensive geriatric care (CGC) at home for frail elderly.METHOD: Case managers invited new CGC patients of one care organization for participation in the study. At two moments, questionnaires were conducted on (social) functioning, quality of life, perceived problems, perceived informal caregiver burden, and self-management. Information on received care was collected from the patients' medical records, In addition, a questionnaire was administered to the referring physician. Feasibility was evaluated descriptively on three domains; inclusion, follow up, and data collection.RESULTS: The intended number of 25 participants was not reached, mostly because clients did not comply with inclusion criteria, and because case managers felt uncomfortable asking patients for participation in the study. Of the 14 participants, 12 were followed until the follow-up measurement. Several questionnaire domains appeared difficult to answer for participants. It also appeared difficult to collect information on received care from the medical records. Questionnaire response among general practitioners was 6 out of 11.CONCLUSION: Due to the vulnerability of the targeted group and logistical challenges, the inclusion of participants for the study was more difficult than originally thought. In combination with the difficulties in data collection, this suggests that a large-scale study on the content and effect of CGC is not feasible. Qualitative research methodologies, preferably combined with quantitative methods, offer better opportunities to understand the value of CGC for frail elderly living at home.

To evaluate the feasibility of a study on the content and effect of comprehensive geriatric care (CGC) at home for frail elderly.Case managers invited new CGC patients of one care organization for participation in the study. At two moments, questionnaires were conducted on (social) functioning, quality of life, perceived problems, perceived informal caregiver burden, and self-management. Information on received care was collected from the patients' medical records, In addition, a questionnaire was administered to the referring physician. Feasibility was evaluated descriptively on three domains; inclusion, follow up, and data collection.The intended number of 25 participants was not reached, mostly because clients did not comply with inclusion criteria, and because case managers felt uncomfortable asking patients for participation in the study. Of the 14 participants, 12 were followed until the follow-up measurement. Several questionnaire domains appeared difficult to answer for participants. It also appeared difficult to collect information on received care from the medical records. Questionnaire response among general practitioners was 6 out of 11.Due to the vulnerability of the targeted group and logistical challenges, the inclusion of participants for the study was more difficult than originally thought. In combination with the difficulties in data collection, this suggests that a large-scale study on the content and effect of CGC is not feasible. Qualitative research methodologies, preferably combined with quantitative methods, offer better opportunities to understand the value of CGC for frail elderly living at home.

To explore stroke patients needs of care after discharge from hospital or rehabilitation facility.Semi-structured interviews with twenty stroke patients and their partners in the region Midden-Kennemerland in the Netherlands.'That's when it really begins'; at home it becomes clear what the real consequences of the stroke are on daily life. After returning home patients would have liked to (1) have had more information/support and they have a need for support for a long time after their stroke; (2) have had the possibility to get support later on (after having said 'no' in the first place). On the other hand there are (3) patients who are inclined to search for solutions by themselves.Only after returning home stroke patients and their partners can really assess what their need for care is. Therefore the need for care of stroke patients should be assessed after a period of time after the patients return home. The care should be available for a long time after the stroke. Because patients don't realize that they can get help for the neuropsychological consequences, it is important that the initiative to organize the care lies in the hands of the caregivers.

Most elderly people attach great value to staying functionally independent for as long as possible. A targeted detection and treatment of factors that threaten functional independence, through comprehensive geriatric assessment, might promote this. This paper describes a review on the effect of in-home comprehensive geriatric assessment.A search was carried out in Pubmed (1977-2012) for randomized controlled trials investigating the effectiveness of multidisciplinary multidimensional in-home geriatric assessment. Data was extracted about effectiveness, costs and factors that had a positive or negative influence on the outcome of CGA.Nine RCTs could be included in the study. All studies were of moderate to good quality, except for one study of poor quality. A positive effect was found in three out of six studies on functional status and in two out of four studies on quality of life. No effect was found on number of hospital admissions, nursing home admissions and on mortality. Most studies showed a rise in total health care expenditure.In-home CGA has a modest positive effect on functional status and quality of life. Evidence suggest that in-home CGA might be most effective in elderly that have a relatively high level of functioning.

In general older adults, even the oldest old are community dwelling and vital. However, vulnerability can silently or suddenly exist. Multidisciplinary assessment of health problems and disabilities is necessary to compose a comprehensive intervention program. In the Netherlands, a team specialised in elderly care accomplishes home-based assessments. In 2009 we conducted a case study aiming to describe the characteristics of the patients and the reasons for consultation. A total of 84 records were analysed. 60% of the clients were 85 years or older, 32% were living independently and 61% were residents in homes for elderly people. The majority of clients was female and living alone (widowed). Most clients had multiple issues and were referred for cognitive evaluation. During the process of assessment many underlying behavioural, emotional and social problems became manifest. These findings support that symptoms and complaints of frail elderly are complex. A systematic multidisciplinary approach enhances the dialogue with patients and caregivers to discuss their needs and their attitude towards care. More research, however, is necessary to evaluate the effectiveness of this intervention.

Onder toezichthoudende domotica verstaan we elektronische apparatuur waarmee een bewoner op afstand in de gaten kan worden gehouden. Dergelijke technologie is in opkomst in de residentiele zorg voor mensen met dementie. Handig, zou je zeggen. En dat is het in veel gevallen ook. Maar domotica als bewegingsmelders, detectiechips, uitluistersystemen, camerabewaking en gps is meer dan een verzameling handige technologische snufjes waarvan je alleen maar hoeft te weten hoe je ze moet bedienen. Als zorgprofessional moet je ook weten wat het gebruik ervan met de bewoners doet. En of het in alle gevallen wel oplevert wat je ervan verwacht.

This article discusses the results of a Concept Mapping, held to clarify the concept of small-scale group living for elderly with dementia. Seventeen experts from different backgrounds formulated 91 statements about small-scale group living. These were subsequently depicted on a concept map with two dimensions: care versus living and individual versus context. The statements were then divided into six clusters by hierarchical cluster analysis. Five of these clusters centred around the arrangements of the individual lives of the residents and the collective lives of residents and staff, while only one held statements about the physical characteristics of small-scale group living. Therefore, it can be concluded from this Concept Map that small-scale group living is not so much determined by the physical characteristics but by the organisational features of the care context.

The article reports on a study involving participants in six projects set up jointly by mental health care facilities and homes for the elderly. The projects were designed to offer protection and guidance in residential homes to older people whose psychiatric problems have rendered them permanently dependent on professional care. The primary focus of the study was on their problems and care needs. Structured interviews were conducted with 136 residents and with their supporting and treating staff. The older people presented an atypical pattern of symptoms. The supporting staff and the treating staff both cited the unsociable, apathetic behaviour of the residents as the most serious problem, followed by emotional problems. Only 37% of the residents were free of cognitive problems, and only 18% had no physical impairments. Although the projects were specifically designed for older people suffering long-term mental instability, more than a quarter of the residents turned out to have had little or no contact with mental health care services. Many had even been admitted to the projects with no prior psychiatric assessment. The study recommends that the projects mobilise more mental health expertise in carrying out needs assessment. To help alleviate the residents' apathy, in-service training programmers for the care staff should focus not on psychopathology alone, but also on ways to create a more stimulating residential and social atmosphere.

This article reports on the number of older people with functional psychological problems who receive mental health care. It uses a filtermodel, that shows which filters have to be passed to receive mental health care. The model describes five levels of morbidity. Based on literature the prevalence of functional psychiatric disorders in the community (level I) is estimated between 170 and 330 per 1.000 persons older than 65 a year. This range doesn't differ from the prevalence range of younger adults. One Dutch representative study is used to estimate the prevalence of psychological and/or social problems that elderly present to their general practitioner (GP) (level III). It is estimated at 189 per 1.000 persons. Based on registration data the prevalence of psychiatric care use by persons with a functional disorder (level IV) is estimated at 27 per 1.000 older persons a year. This implies that only a small percentage (8 to 16%) of the people with functional psychological problems receive mental health care. We conclude that compared to younger adults the accessibility of mental health care is worse for elderly adults. Elderly persons probably seek less help than younger people. But there is also some evidence of age discrimination by professional staff. Furthermore, psychogeriatric clinical syndromes are difficult to diagnose. The elderly cross the threshold to the fifth level more easily than younger adults; they are relatively often referred to institutional mental health care.